DESCRIPTION (Applicant's Description) Translating effective treatment approaches for smoking cessation to the pediatric emergency room setting will allow us to reach populations which are less accessible through more traditional channels. As children present with acute respiratory tract problems, including otitis media, pneumonia, and asthma, health care providers have the unique opportunity to motivate parents/caretakers to quit smoking as a means of reducing risk of recurrent illness for their children, as well as for themselves. Therefore, we propose to test the incremental efficacy of brief physician advice plus a motivational counseling intervention-and follow-up on parental smoking cessation rates over advice alone. The defined population will be parents who smoke accompanying children who present with respiratory problems. This population includes a high proportion of low income, low education, multiethnic smokers who will also vary in their readiness to quit smoking. Smokers will be randomly assigned to one of two intervention conditions, (a) brief physician advice (standard treatment); and (b) brief physician advice, with the addition of a tailored motivational intervention, behavioral skills counseling (for parents willing to make a quit attempt), and tailored follow up mailings to the parent and to the child's primary care provider to reinforce the key messages (enhanced intervention). The enhanced intervention is based on a motivational interviewing approach and stages of change, with multiple messages from multiple providers. These treatment components were selected to maximize effectiveness while maintaining cost efficiency and generalizability for other ER settings. We hypothesize that 6-month 7-day point prevalence quit rates will be 5 percent and 10 percent in each of the two treatment groups, respectively. This study is the first to evaluate the efficacy of smoking cessation intervention for parents in the emergency room setting. If successful, the results of the study can be generalized to similar populations in other emergency room settings, where the burden of smoking-related illness is felt most acutely.